1. بسم الله الرحمن الرحیم dr asadian amoli 1391-24 bahman

2. سلام به همکاران عزیز dr asadian amoli 1391-24 bahman

3. DYSPNEA dr asadian amoli 1391-24 bahman by Dr Asadollah Asadian

4. Dyspnea - common complaint/symptom “shortness of breath” or “breathlessness” Defined as abnormal/uncomfortable breathing Multiple etiologies - 2/3 of cases - cardiac or pulmonary etiology dr asadian amoli 1391-24 bahman

5. HOW TO DESCRIBE THESE SENSATIONS Cannot get enough air Air does not go all the way down Smothering feeling in the chest Tightness in the chest Fatigue in the chest dr asadian amoli 1391-24 bahman

6.  Normal person may experience the physiologic dyspnea during heavy exercise dr asadian amoli 1391-24 bahman

7. DIFFERENTIAL DIAGNOSIS Composed of four general categories Cardiac Pulmonary Mixed cardiac or pulmonary non-cardiac or non-pulmonary dr asadian amoli 1391-24 bahman

8. PULMONARY ETIOLOGY COPD Asthma Restrictive Lung Disorders Hereditary Lung Disorders Pneumonia Pneumothorax dr asadian amoli 1391-24 bahman

9. CARDIAC ETIOLOGY CHF CAD MI (recent or past history) Cardiomyopathy Valvular dysfunction Left ventricular hypertrophy Pericarditis Arrhythmias dr asadian amoli 1391-24 bahman

10. MIXED CARDIAC/PULMONARY ETIOLOGY COPD with pulmonary HTN and/or cor pulmonale Chronic pulmonary emboli Pleural effusion dr asadian amoli 1391-24 bahman

11. NONCARDIAC OR NONPULMONARY ETIOLOGY Metabolic conditions (e.g. acidosis) Pain Trauma Neuromuscular disorders Functional (anxiety,panic disorders, hyperventilation) Chemical exposure dr asadian amoli 1391-24 bahman

12. TOXIC DYSPNEA In the metabolic acidosis (uremiaand diabetic acidosis, the acid metabolites stimulate the respiratory center, causing deep and regular respiration (Kussmanul) with snoring. dr asadian amoli 1391-24 bahman

13. ACUTE DYSPNEA PTE Pneumonia Asthma Anxiety MI dr asadian amoli 1391-24 bahman

14. There is no one specific cause of dyspnea and no single specific treatment Treatment varies according to patient’s condition chief complaint history exam laboratory & study results dr asadian amoli 1391-24 bahman

15. نا رسایی تنفسی dr asadian amoli 1391-24 bahman

16. انواع نارسایی تنفس هیپوکسمیک (تیپ1 ) هیپرکاپنیک (تیپ2) dr asadian amoli 1391-24 bahman

17. نا رسایی حاد تنفسی =نارسایی تنفسی هیپوکسمیک po2<60mmgh w FIO2=>50 هیپرکاپنیک نارسایی تنفسی=PCO2.>45mmgh+acidosis dr asadian amoli 1391-24 bahman

18. علل هیپوکسی FIO2 کاهش اختلال دردیفیوژن شنت هیپوونتیلاسیون V/Q mismatch dr asadian amoli 1391-24 bahman

19. شایع ترین علت نارسایی شنت استICU تنفسی در dr asadian amoli 1391-24 bahman

20. علل شنت intracardiac any cause of a right to left shunt eg Fallot's tetralogy, Eisenmenger's syndrome pulmonary pneumonia pulmonary oedema atelectasis collapse pulmonary haemorrhage pulmonary contusion dr asadian amoli 1391-24 bahman

21. تهویه بدون پرفیوژن هوا واردریه می شود ولی تبادل گاز صورت نمی گیرد(به علت فقدان پرفیوژن)در نتیجه الوئولها همانند راه هوایی (physiological dead space )عمل میکنند( ) low cardiac output( علل- نارسایی قلبی افزایش فشارداخل الوئولی (تهویه مکانیکی) dr asadian amoli 1391-24 bahman

22. CAUSES OF HYPOVENTILATION  Brainstem brainstem injury due to trauma, haemorrhage, infarction, hypoxia, infection etc metabolic encephalopathy depressant drugs Spinal cord trauma, tumour, transverse myelitis Nerve root injury Nerve trauma neuropathy eg Guillain Barre motor neuron disease Neuromuscular junction myasthenia gravis neuromuscular blockers Respiratory muscles fatigue disuse atrophy myopathy malnutrition Respiratory system airway obstruction (upper or lower) decreased lung, pleural or chest wall com dr asadian amoli 1391-24 bahman

23. NERO-PSYCHOGENIC DYSPNEA Patient suffer from hysteria will be seen repetitive deep, signing respiration with numbness of extremities or lips, spasm. dr asadian amoli 1391-24 bahman

24. HAEMATOLOGICL DYSPNEA  The decrease of oxygen-carrying capacity and oxygen content develop abnormal respiration and increase heart rate, such as severe anemia, carbon monoxide.  Hypotension can stimulate respiration when patient suffer from shock. dr asadian amoli 1391-24 bahman

25. ACCOMPANYING SYMPTOMS Paroxysmal dyspnea with wheezing, It is present in bronchial asthma and cardiac asthma. Paroxysmal severe dyspnea is often seen in acute larynx edema(spontaneous pneumothoraxmassive pulmonary embolism. dr asadian amoli 1391-24 bahman

26. ACCOMPANYING SYMPTOMS Dyspnea with chest pain. It is frequently observed in lobar pneumoniapulmonary infarction(), spontaneous pneumothorax, acute exudative pleurisy), acute myocardial infarctionand bronchial carcinoma``````````````````````` dr asadian amoli 1391-24 bahman

27. ACCOMPANYING SYMPTOMS Dyspnea with fever. It is commonly noted in pneumonia, lung abscesspulmonary tuberculosispleurisy, acute pericarditisand nervous system diseases. dr asadian amoli 1391-24 bahman

28. ACCOMPANYING SYMPTOMS Dyspnea with cough and purulent sputum. It is often present in chronic bronchitis, obstructive pulmonary emphysema with infection, purulent pneumonia, and lung abscess; Dyspnea with large amount of foamy sputum is often seen in acute left ventricular heart failure and organophosphorus poisoning dr asadian amoli 1391-24 bahman

29. ACCOMPANYING SYMPTOMS Dyspnea with coma. It suggests cerebral hemorrhage(pneumonia with shock, uremia, diabetic ketoacidosis, and acute poisoning. dr asadian amoli 1391-24 bahman

30. COMMON CAUSES OF TYPE I (HYPOXEMIC) RESPIRATORY FAILURE  Chronic bronchitis and emphysema (COPD)  Pneumonia  Pulmonary edema  Pulmonary fibrosis  Asthma  Pneumothorax  Pulmonary embolism  Pulmonary arterial hypertension  Pneumoconiosis  Granulomatous lung diseases  Cyanotic congenital heart disease  Bronchiectasis  Adult respiratory distress syndrome  Fat embolism syndrome  Kyphoscoliosis  Obesity dr asadian amoli 1391-24 bahman

31. COMMON CAUSES OF TYPE II (HYPERCAPNIC) RESPIRATORY FAILURE  Chronic bronchitis and emphysema (COPD)  Severe asthma  Drug overdose  Poisonings  Myasthenia gravis  Polyneuropathy  Poliomyelitis  Primary muscle disorders  Porphyria  Cervical cordotomy  Head and cervical cord injury  Primary alveolar hypoventilation  Obesity hypoventilation syndrome  Pulmonary edema  Adult respiratory distress syndrome  Myxedema  Tetanus dr asadian amoli 1391-24 bahman

32. EASILY PERFORMED DIAGNOSTIC TESTS Chest radiographs Electrocardiograph Screening spirometry dr asadian amoli 1391-24 bahman

33. Commonly used to evaluate acute dyspnea can provide information about altered pH, hypercapnia, hypocapnia or hypoxemia normal ABGs do not exclude cardiac/pulmonary dx as cause of dyspnea Remember- ABGs may be normal even in cases of acute dyspnea ABGS dr asadian amoli 1391-24 bahman

38. Bilateral airspace infiltrates on chest radiograph film secondary to acute respiratory distress syndrome that resulted in respiratory failure dr asadian amoli 1391-24 bahman

42. A 44-year-old woman developed acute respiratory failure and diffuse bilateral infiltrates. She met the clinical criteria for the diagnosis of acute respiratory distress syndrome. In this case, the likely cause was urosepsis dr asadian amoli 1391-24 bahman

46. با تشکر از توجه شما dr asadian amoli 1391-24 bahman

47. QUESTIONS? dr asadian amoli 1391-24 bahman